“E-cigarettes have taken us back 50 years,” according to the headline over a commentary that National Jewish Health, a medical centre in Denver, recently paid to place on the op-ed page of The New York Times. The essay — co-authored by David Tinkelman and Amy Lukowski, who are in charge of the hospital’s “health initiatives,” including its tobacco-cessation program — never substantiates that claim, which is typical of e-cigarette critics who see a public-health menace where they should see a way of reducing tobacco-related disease and death.

[np_storybar title=”Selby, Sweanor & Hughes: E-cigarettes could save the government billions” link=”http://fullcomment.nationalpost.com/2014/02/26/selby-sweanor-hughes-e-cigarettes-could-save-the-government-billions/”%5DInnovation is a powerful thing. It has dramatically increased our quality of life, and the entrepreneurial spirit behind it continues to amaze us. If someone from 1964 were to see the computers, automobiles or medical diagnostics we have today, they would be astounded. But former U.S. surgeon-general Luther Terry, who released the first ground breaking Report of the Surgeon General on Smoking and Health 50 years ago, would be saddened that cigarettes have not appreciably changed. They are still the same deadly and defective delivery system for nicotine and they remain, by far, the leading cause of preventable death, despite sound policy and improved treatment.

Although there has been little to no innovation in cigarettes (evidence suggests they may actually be more harmful today than they were in the past), there have been great advances in potentially massively less harmful ways to deliver nicotine to the body, such as electronic cigarettes. Unfortunately, Health Canada’s policy to these game-changing devices has been confused, to say the least.

You might think people concerned about the health effects of smoking would welcome an alternative that involves neither tobacco nor combustion and is therefore much less hazardous. But with some notable exceptions, anti-smoking activists and public-health officials have been mostly hostile to electronic cigarettes, which deliver nicotine in a propylene glycol vapour. This puzzling resistance seems to be driven by emotion rather than science or logic.

Tinkelman and Lukowski concede that “e-cigarette vapor contains far fewer toxic chemicals and carcinogens than does tobacco smoke” and that “if e-cigarettes are used to wean individuals off tobacco or to significantly reduce the amount smoked per day, this is a good result.” But they worry that “if e-cigarettes used by non-smokers produce nicotine addiction and smoking habits that lead to new tobacco use, e-cigarettes are causing harm.” Judging from their headline, Tinkelman and Lukowski think that harm not only threatens to outweigh the health benefits of replacing smoking with vaping but could even reverse half a century of progress against tobacco-related disease, giving us smoking rates similar to those in the early 1960s, when most American men and a third of women smoked — compared to about 22% and 17%, respectively, today.

Despite Tinkelman and Lukowski’s over-the-top fears, there is no evidence that e-cigarettes are serving as a gateway to the real thing. They cite survey data indicating that “e-cigarette use among middle and high school students from 2011 to 2012 doubled to 1.8 million users,” adding that “nearly 160,000 of those adolescents do not use tobacco, highlighting the danger e-cigarettes present.” Another way of putting it: Just 7% of teenagers had ever tried e-cigarettes as of 2012, and 91% of them were smokers. Far from alarming, that fact suggests some young smokers may end up switching to vaping, thereby dramatically reducing the health risks they face. That would be “a good result,” as Tinkelman and Lukowski acknowledge.

What about the nonsmokers who account for 9% of the teenagers who have tried e-cigarettes? There is little reason to think they will become regular vapers, let alone smokers. In a 2013 survey of 1,300 college students, only one respondent reported trying e-cigarettes before smoking the conventional kind. “It didn’t seem as though it really proved to be a gateway to anything,” said the lead researcher. Consistent with that observation, the same survey that Tinkelman and Lukowski cite with alarm shows that smoking among teenagers fell as vaping rose.

Tinkelman and Lukowski complain that “the marketing of these products … clearly has been developed to glamorize vaping and attract young people,” which they say “cannot be tolerated by society.” The term “young people,” which could refer to chain-smoking 25-year-olds as well as tobacco-naive 13-year-olds, is perhaps deliberately ambiguous. But the bottom line is this: Without all that intolerable “marketing” (a.k.a. speech), fewer cigarette smokers will be aware of a competing product that could literally save their lives. Tinkelman and Lukowski would sacrifice the health of actual smokers in the name of saving imaginary “young people” who never would have started smoking if they hadn’t experimented with e-cigarettes in high school.

The main argument for prohibiting vaping along with smoking is that it looks too much like the real thing. That resemblance, of course, is what makes e-cigarettes such a promising harm-reduction tool

Similarly, Tinkelman and Lukowski praise New York, Boston and Los Angeles for taking “admirable steps to regulate e-cigarettes.” Those steps include treating vaping the same as smoking, meaning that e-cigarettes are banned wherever conventional cigarettes are, even though there is no evidence that e-cigarette vapor poses a hazard to bystanders. Since that policy eliminates an important advantage of switching from smoking to vaping, it could ultimately result in more tobacco-related disease and death, which is not an outcome that should be welcomed by people who run a smoking-cessation program.

The main argument for prohibiting vaping along with smoking is that it looks too much like the real thing. That resemblance, of course, is what makes e-cigarettes such a promising harm-reduction tool, since they mimic smoking while avoiding the toxins and carcinogens generated by tobacco combustion. But opponents of e-cigarettes worry that public vaping will sow confusion among adults charged with enforcing smoking bans, and among children who might mistakenly think cigarettes aren’t so bad after all. Those hypothetical problems seem overblown to me, but I will concede this much: E-cigarettes definitely sow confusion among anti-smoking activists.

National Post

Jacob Sullum, a senior editor at Reason magazine, is the author of For Your Own Good: The Anti-Smoking Crusade and the Tyranny of Public Health (Free Press).

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